Most people know very little about the Medicaid program – and what they think they know may be incorrect. For instance, did you know that although Medicaid does provide health insurance for low income individuals and families, it also provides coverage for the disabled and elderly? Moreover, the odds are very good that you will need the benefits offered by Medicaid during your golden years. One area of considerable confusion within the Medicaid program is the “waiver” program. If you do end up relying on Medicaid benefits at some point in time you should have at least a basic understanding of what a Medicaid waiver is and how to apply for one.
The primary reason why a significant percentage of the elderly end up relying on Medicaid is because Medicaid covers the costs associated with long-term care – something that most private health insurance policies and Medicare do not cover. Statistics tell us that at the time you retire you stand a one in two chance of needing long-term care before you die. If you make it another 20 years, to age 85, those odds increase to three in four.
Although Medicaid covers long-term care provided in a facility such as a nursing home, many elderly individuals would prefer to receive that care in their own homes. Moreover, many remain capable of living in their home if they can just arrange for some specialized in-home care. This is where Medicaid waivers come in. In general, a waiver allows a state to waive a specific requirement or procedure, or to change the traditional method of providing care, in an effort to provide more cost effective and/or customized care to a recipient. Though the Medicaid program is primarily funded by the federal government, it is administered at the state level. For this reason, the waivers available will vary by state; however, most states have at least one waiver program that allows a recipient to receive care at home instead of in a long-term care facility.
The State of Illinois has nine Home and Community Based Services Waiver Programs, or HCBS. One of those nine programs is specifically aimed at the elderly and provides in-home services (homemaker) adult day services, and emergency home response service when needed. Along with meeting the basic eligibility requirements for the Medicaid program, you will also need to be at risk of nursing facility placement and be able to be safely maintained at home with the assistance of the services provided through the waiver. Finally, the cost of the in-home care must be less than institutionalized care.
If you have specific questions about Medicaid planning, elder law, or the Medicaid waiver program, consult with your Illinois estate planning attorney.
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